Diagnosing vulvar cancer

The first step in diagnosing vulvar cancer involves a physical exam, during which your doctor will perform a thorough pelvic exam. The doctor will also examine your vulva, anus, rectum, bladder, ovaries, vagina and uterus for unusual changes. A Pap smear and/or HPV test may also be performed.

At each of our hospitals, standard-of-care and innovative vulvar cancer treatments and technologies are available—all under one roof. Our vulvar cancer experts use a wide variety of diagnostic tools, including imaging and laboratory tests, to evaluate vulvar cancer. This diagnostic evaluation takes about three to five days.

Then together, we develop a comprehensive vulvar cancer treatment plan tailored to you and your needs. Your individualized plan will evidence-based medical treatments and technologies, combined with supportive care services designed to help reduce side effects and keep you strong in body, mind and spirit.

Common diagnostic tests used to evaluate vulvar cancer include:

X-ray: An X-ray, a type of high-energy electromagnetic radiation, is often used for medical imaging. This image-guided technology is an important procedure for cancer diagnosis, staging and treatment. In diagnosing vulvar cancer, a standard X-ray of the chest may be performed to determine whether the cancer cells have spread to the lungs.

CT scan: Computed tomography (CT) scan (also known as a computed axial tomography scan, or CAT scan) is an X-ray procedure that uses a computer to produce three-dimensional, cross-sectional images of inside the body. Unlike conventional X-rays, CT scans provide exceptionally detailed images of the bones, organs and tissues. X-rays are taken from many angles and combined to create a cross-sectional image. A CT scan for vulvar cancer is usually used to help determine the size and shape of the tumor, or to see if the cancer has spread to lymph nodes or other areas of the body.

MRI: Magnetic resonance imaging (MRI) is an imaging tool designed to create detailed, cross-sectional pictures of the inside of the body. Using radiofrequency waves, powerful magnets and a computer, MRI systems may distinguish between normal and diseased tissue. MRI is often used for patients with cancers in the pelvic region, and may help identify enlarged lymph nodes in the groin, which may indicate that the cancer has spread. MRI is also used to determine if the cancer has spread to the brain or spinal cord.

PET/CT scan: This advanced nuclear imaging technique combines positron emission tomography (PET) and computed tomography (CT) into one machine. A PET/CT scan reveals information about both the structure and function of cells and tissues in the body during a single imaging session. PET scans may help find small metastases or determine if enlarged lymph nodes contain cancer cells. While PET scans are very sensitive, they do not show much detail. That's why they are often performed in combination with a CT scan.

Proctosigmoidoscopy and cystoscopy: In these two similar procedures, a doctor will use a flexible, thin hollow tube with a lens and a light on the end to examine the rectum and colon or the bladder. A proctosigmoidoscopy is used to examine the rectum and colon, while a cystoscopy is used to view the bladder. In evaluating vulvar cancer, proctosigmoidoscopy and cystoscopy are used to detect whether the cancer has spread to the rectum, colon or bladder.

Sentinel lymph node biopsy: Sentinel lymph node biopsy is used to diagnose and stage vulvar cancer by helping to determine whether the cancer has spread (metastasized). During a sentinel lymph node biopsy, a radioactive substance and/or a dye is injected near the tumor site. The first lymph nodes that absorb the dye are identified as sentinel lymph nodes, because they are the first lymph node drainage to which cancer is most likely to spread from a primary tumor. More than one lymph node may be considered a sentinel lymph node.

For patients with vulvar cancer, sentinel lymph node biopsy may reduce infections, wound breakdown and lymphedema. Removing only one or two lymph nodes also may avoid complications that can come with surgery to remove 10-30 lymph nodes.